It has been 10 years since we authored our first blog post here on Our Milky Way. Ten. Years. This milestone is accompanied by a myriad of emotions!
I’m so proud of our collection of publications, promoting fantastic work by fantastic people.
I am stunned by the elusiveness of time; I first took the Lactation Counselor Training Course (LCTC)– which propelled me into this work– when my first child was only a few months old and now she is 11.
I am deeply grateful for everything I’ve learned from our participants and my colleagues and mentors who have shaped this blog. It’s such a thrill to connect with people across the continent and across the oceans, and I consider it such a privilege to have spent time with all of the beautiful minds featured on this blog.
I am both discouraged and encouraged. Scrolling through a decade’s worth of stories leaves me inspired by maternal child health advocates’ tireless work and triumphs both big and small. Lactation spaces have been carved out and employers have adopted breastfeeding-friendly policies, breastfeeding murals have been painted, generous human milk donations have been made, babies have gone skin-to-skin in the operating room, World Breastfeeding Weeks have been celebrated, important research has been conducted and published, and the accomplishments go on and on!
I’m also disheartened by the darker spaces where negative forces are at play like conflict among care providers, our culture’s disconnect between birth and breastfeeding, systemic racism, no paid parental leave, and the pervasive industry influence in infant feeding and beyond. These, among other forces, leave the United States consistently dangling near the bottom of the WBTi World Ranking list.
Despite our country’s poor performance in supporting healthy beginnings, I still find myself with a sense of wonder and cautious optimism for what the next decade holds for familial, community and global health.
In celebration of Our Milky Way’s 10th birthday, we’re launching a series called “Breastfeeding is…” For ten weeks, we will revisit a topic that describes breastfeeding. This series was inspired specifically by our 2013 piece Breastfeeding is… where Healthy Children Project faculty emeritus Barbara O’Connor, RN, BSN, IBCLC, ANLC discusses what breastfeeding can be and the cultural forces at odds with positive health outcomes.
Join us in celebrating and honoring healthy infant feeding by sharing what breastfeeding means to you. You can post in the comments below, find us on social media @centerforbreastfeeding, or email us at email@example.com.
What’s more, I am so pleased to announce that we will be giving away an online learning module with contact hours each week of our 10 week celebration. Here’s how to enter into the drawings:
This week, in the body of the email, tell us what breastfeeding means to you. Subsequent weeks will have a different prompt in the blog post.
We will conduct a new drawing each week over the 10-week period. Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.
“We are the ones we have been waiting for,” Jordan penned.
It embodies the #BMHW22 theme, “Building for Liberation: Centering Black Mamas, Black Families and Black Systems of Care”. The theme reflects founding and leading organization Black Mamas Matter Alliance’s (BMMA) work in centering Black women’s scholarship, maternity care work, and advocacy across the full-spectrum of sexual, maternal, and reproductive health care, services, programs, and initiatives.
The BMHW22 campaign is a week of awareness, activism, and community building intended to:
Deepen the national conversation about Black maternal health in the US;
Amplify community-driven policy, research, and care solutions;
Center the voices of Black Mamas, women, families, and stakeholders;
Provide a national platform for Black-led entities and efforts on maternal health, birth and reproductive justice; and
You can watch BMMA’s National Call surrounding the fifth-year anniversary of BMHW here which highlights all of the major activities happening online and across the nation in celebration of Black mothers and their families. On April 17, individuals have the opportunity to get to know the organizations that make up BMMA, Black-led organizations that are doing the work and making a difference for BIPOC families. Of those organizations is reproductive justice organization Restoring Our Own Through Transformation (ROOTT). ROOTT’s Jessica Roach’s TEDx talk is just one example that encapsulates both the maternal infant health crisis we find ourselves in and the triumphs that are to be elevated.
“…In a world as complex and interconnected as the one we live in, the idea that one person has the answer is ludicrous. It’s not only ineffective, it’s dangerous because it leads us to believe that it’s been solved by that hero, and we have no role. We don’t need heroes. We need radical interdependence, which is just another way of saying we need each other.”
In reference to the despicable maternal child health outcomes for birthing and lactating Black Indigenous People of Color (BIPOC), Seals Allers implores us to stop having “this very individualized conversation about what is happening to Black women.”
“There is so much involved,” she says. “There is no single solution, and there never was a single source of the problem.”
It’s a tangle that calls for more than reduction, reusing and recycling.
Through an equity lens, Seals Allers uses Bruce Bekkar’s, MD, et al research to ask questions like “Why are there factories mostly in Black and Brown neighborhoods? Why were Black and Brown people driven to heavily populated urban areas?”
The association between air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the U.S., demonstrated in Bekkar’s research, is heavily influenced by systemic racism.
Flavelle goes on, “Adrienne Hollis, senior climate justice and health scientist for the Union of Concerned Scientists, said the problems could not be tackled in isolation. ‘We need to look at policies that provide equitable opportunities for communities of color,’ Dr. Hollis said. ‘If you address structural racism, I think you’re going to start getting at some of these issues.’”
Seals Allers echoes: “Stop problematizing Black women; look at the systemic solutions.”
Unsurprisingly, the “solutions” we tend to generate include pouring millions of dollars into synthetic milk instead of investing in breastfeeding and lactating people themselves.
“It’s very disturbing,” Seals Allers comments in her Facebook stream. “The solution is not around empowering women, it’s not about getting women breastfeeding, it’s about finding synthetic solutions. [There’s ] such a disconnect.”
Equally concerning in this case, is that the investment into a proposed solution for poor health outcomes related to not breastfeeding, comes from a climate change investment fund. Human milk is arguably the most sustainable food on our planet; why are sub-optimal, artificial substitutes getting so much funding instead of promoting policies and programs that support direct breastfeeding or pasteurized donor human milk?
The conundrum goes beyond the years of milk feeding onto complementary foods which offer corporations new opportunities to target families with Ultraprocessed Foods (UPF). Like artificial milk substitutes, UPFs pose environmental threats: processing takes natural resources and generates waste. Moreover, UPFs are often heavily marketed in underserved communities, so poor health outcomes continue to be compounded.
Healthy Children Project’s Cindy Turner Maffei recently attended a webinar sponsored by the Breastfeeding Promotion Network of India (BPNI) and the Nutrition Advocacy in Public Interest (NAPI) on UPFs and their relation to obesity, diabetes, and other health dangers.
“Presenters from India, Brazil, and Australia shared insights on the health impacts of UPFs, about the market and social forces at play, and also what we can do to advocate reduction in use of these engineered foods,” Turner-Maffei reports. “Brazil in specific has incorporated decreasing UPFs into their dietary guidelines and restricted use of government funds to purchase these foods for school food programs.”
BPNI has also created a WBW action folder. The document contains information on the carbon footprint of breastmilk substitutes and offers interventions required to support breastfeeding at four levels: policy makers, civil society and breastfeeding advocates, hospitals and doctors and parents.
Nothing is relevant if we don’t have a hospitable planet. Breastfeeding and appropriate, unprocessed complementary feeding are the roots of a healthy ecosystem that all humans benefit from.
Our Milky Way spoke with ROSE Chief Empowerment (CEO) and Change Leader Kimarie Bugg, DNP/FNP-BC/MPH/IBCLC/CLC, Vice President Mary Nicholson Jackson, CLC and Program Director Andrea Serano, CLC, IBCLC who provided an update and commentary on the case.
The team says that the recent reversal feels like a victory because it means that the 2016 law is still not enforceable and lactation care providers (LCPs) with any credential can continue their work.
“The problem is that it’s still being misinterpreted in some places,” Jackson explains. “Sometimes trying to figure out what’s going on is the real concern.”
The Georgia Lactation Consultant Practice Act calls to prohibit provision of lactation care and services for compensation without obtaining IBCLC licensure. But in June 2018, the court put a freeze on the implementation of the law after Jackson, in partnership with the Institute for Justice (IJ) and ROSE, filed a lawsuit to preserve the right to earn an honest living.
The recent reversal affects close to 1,000 Certified Lactation Counselors (CLCs) among other breastfeeding helpers practicing in Georgia, all of whom would have not been lawfully permitted to continue their work under the law after July 2018.
The ROSE team explains that while LCPs continue to legally offer services and support, there’s still some confusion within the community. Individuals lobbying for the Lactation Consultant Practice Act have offered up erroneous guidance at places of employment for example.
Especially in the current context of Covid-19, the team expresses relief that they and other lactation supporters are still able to provide support to families. Many long-standing and already-dire situations have been illuminated and compounded during the pandemic, like labor and birth support.
In Georgia, only one support person is allowed to accompany a laboring person in certain maternity care facilities, and that support person is not allowed to leave and return to the hospital. In many cases, this restriction is not sustainable for families who have other children or employment obligations.
“We know that if [the law] would have been in effect, [birthing people] could not fall back on the resources that they know of and are familiar with after already being traumatized after labor and birth,” Bugg explains.
Racial inequities and structural racism have been brought to the forefront of our national conversation especially in light of Covid-19, and the issues at hand are no different in the world of lactation.
Not surprisingly, some have suggested that the entire premise of the Lactation Consultant Practice Act is fraught with racism.
The case is not only about economic freedom, but equally important, access to lactation care especially in marginalized communities.
Jackson’s petition points out that “the Act defeats its own purpose of promoting public health because it will, overnight, put hundreds of highly qualified lactation consultants… out of business. This will dramatically reduce breastfeeding support statewide, particularly in the minority and rural communities where CLCs are most active.”
Pages 19 to 25 of the petition detail ways in which the Act causes harm to LCPs including those who work as milk lab technicians, Baby Café support people, military families, and the list goes on.
Brooks writes, “The systemic racism is made obvious because an IBCLC of color now has to take the time, and money, and lawyer up, and dig through paper work from 29 years ago, and file an appeal, and show people that she is an excellent, honest, forthright person who just wants to **continue** working to help families breastfeed/access human milk, which is what she was showing them when she filed her license application in the first place.”
IJ explains that the “drive toward licensure is not motivated by health or safety concerns, but rather by IBCLCs’ interest in billing health insurance companies for their services.”
“In 2010, the Affordable Care Act mandated that insurance companies provide coverage for lactation services. Since then, insurance companies have used licensure as a means of limiting the expense of that coverage. To ensure they could bill insurance companies, the IBCLCs’ lobbyists have begun pushing state-mandated licenses across the country to artificially differentiate IBCLCs from CLCs,” the IJ statement continues.
SELCA released a response in regard to the Georgia Lactation Consultant Practice Act claiming that the law’s passing “has already improved access to clinical lactation care” citing new jobs, a community college program, and the promise of in-network lactation consultants for mothers using Medicaid.
The ROSE team reports that this large scale change has not transpired.
“That panacea that they thought was going to happen has not happened,” Bugg says.
“Who in the heck thinks any license, waived high over their head by an IBCLC, will now instantly generate credibility, job offers, insurance company cooperation, money in the bank? Anything having to do with payment for/coverage of health care services in the USA in 2018 is a humongous pain-in-the-neck. Ask any hospital, doctor, nurse, midwife, speech therapist, dentist, etc etc etc just how easy-peasy it is to see patients, spend quality time with them, have all services fairly and easily covered, and so on. Yeah. Not so much.
I’ve said it countless times: The issue should be about HOW to pay [for lactation care, from counseling on up through skilled clinical care], not WHO to pay [which is what flawed and even better-than-most licensing bills necessarily must focus on].”
While ROSE moves forward, Serano urges maternal child health advocates to keep the issue of licensure on the radar on a state-by-state basis. When legislation is presented, look at it through an equitable lens, she suggests. Educate local and federal legislators.
On this note, starting at the state level is an effective way to vindicate rights for others, as pointed out in IJ’s video Can the Government Throw You Out of Work? (Not in Some States!). An IJ attorney explains that the U.S. has a long history of looking at what state high courts have done, and that it’s a traditional method for achieving constitutional change.
It’s important to make clear that it is not solely the fault of one or a handful of organizations or individuals for carrying out a racist agenda. We are all called to this work, striving for an antiracist society.
You can stay up to date and support this ongoing case here.